双铂方案治疗有胸水的Ⅲb～Ⅳ期非小细胞肺癌28例

Carboplatin Combined with Cisplatin in the Treatment of Stage Ⅲb～Ⅳ Non-Small Cell Lung Cancer with Malignant Pleural Effusion

目的 :评价卡铂 (CBP)、顺铂 (PDD)联合治疗有胸水的Ⅲb～Ⅳ期非小细胞肺癌的疗效及安全性。方法 :卡铂、顺铂分别经静脉、胸腔给药。静脉途径 :卡铂与盖诺联合 (NP方案 ) ,卡铂按AUC (浓度时间曲线下面积 )计算用量 ,AUC取 5～ 7,dl;盖诺 2 5mg/m2 ,dl,8。每四周一次 ,共 3次。胸腔注射 :NS10 0ml、顺铂6 0 /m2 ,每周一次 ,至胸水消退 ,不超过 4次。结果 2 8例完成治疗 ,可评价疗效。肿瘤达CR1例 (3 6 % ) ,PR12例 (4 2 9% ) ,近期客观有效率 4 6 4 % (13/ 2 8)。胸水达CR10例 (35 7% ) ,PR12例 (4 2 9% ) ,有效率 78 6 %(2 2 / 2 8)。KPS评分增高 10分以上者 18例 (6 4 3% )。中位生存期 7 6个月。发生Ⅲ～Ⅳ度毒副反应共 6例 ,占2 1 4 % (6 / 2 8) ,其中WBC下降 2例 (7 1% ) ,PLT下降 2例 (7 1% ) ,恶心、呕吐 1例 (3 6 % ) ,周围神经炎 1例 (3 6 % )。无治疗相关性死亡。结论 :卡铂、顺铂联合 ,经不同途径给药 ,由于抗肿瘤作用相加 ,而毒性作用分担 ,治疗有胸水的Ⅲb～Ⅳ期非小细胞肺癌疗效好 ,副反应小 ,可安全用于临床。

Objective:To evaluate the clinical efficacy of Carboplatin and Cisplatin for stage Ⅲb～Ⅳ non-small cell lung cancer with malignant pleural effusion.Mothods:Intraveimous use:NP regimen.NVB 25mg/m 2 iv bolus,dl,8,CBP iv bolus dl.The dose of CBP calculated with AUC,and AUC selected 5～7.Repeated every 4 weeks,12 weeks for 1 therapeutic course.Intrapleural injection:NS 100ml?DDP 60mg/m 2,once a week until pleural effusion dropped,no more than 4 times in all.The overall response rates were calculated with CR+PR.Results:28 cases were evaluated for response.The overall response rates of neoplasm and pleural effusion were 46.4%(13/28)and 78.6%(22/28),respectively.The median survival time were 7.6 months.The toxicity and side effects were low.There was no treatment-related death.Conclusion:The combined chemotherapy Carboplatin and Cisplatin in different way to add more Anti-neoplasm effects of the two drugs and reduce the toxicity of treatment of stage Ⅲb～Ⅳ non-small cell lung cancer with pleural effusion.